Experience of surgical management of acute and chronic post-traumatic elbow instability. A retrospective study

Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 5-8 | Felipe Patricio Cichero, Warner Larrondo, Juan Antonio Castellaro, Gonzalo Díaz, Julio Terán


Authors: Felipe Patricio Cichero [1], Warner Larrondo [2], Juan Antonio Castellaro [3], Gonzalo Díaz [3], Julio Terán [3]

[1] Fellow of shoulder and elbow surgery Clínica Dávila, Santiago, Chile.
[2] Chief of shoulder and elbow surgery unit Clínica Dávila, Santiago, Chile.
[3] Staff surgeon of shoulder and elbow unit Clínica Dávila, Santiago, Chile.

Address of Correspondence
Dr. Felipe Patricio Cichero,
Clínica Dávila, Recoleta 464, Recoleta, Santiago, Chile.
Email: felipe.cichero@gmail.com


Abstract

Background: The elbow is the second most commonly dislocated major joint in adults.Elbow dislocation can lead to acute or chronic instability. There are different surgical options and functional outcomes in both cases. The purpose of this study is to assess the functional outcomes and the postoperative complications of these two groups.
Methods: We retrospectively reviewed the functional outcomes of cases of acute and chronic post-traumatic elbow instability that were surgically managed between 2013 and 2016 in adult population. All patients were assessed radiographically and clinically using the Mayo Elbow Performance Score and The Disabilities of the Arm, Shoulder and Hand Score at six months follow-up.
Results: Four male patients were included, two in each group of acute and chronic instability. In Three cases the medial and lateral collateral ulnar ligaments were reconstructed using semitendinosus allograft. In one case the repair of both collateral ligaments was performed usingsuture anchors. Two acute coronoid fractures were managed by using the lasso-type technique and one nonunion treated with two cannulated screws. The mean post operative Mayo Elbow Performance Score were 95 for the acute instability group and 85 for the chronic instability group. The mean Disabilities of the Arm, Shoulder and Hand post operative scores were 5,8 and 18,3 for the acute and chronic instability groups respectively. There was one case of ulnar neuropaxia that resolved spontaneously at two months follow-up. All patients had a reduced and concentric elbow in control radiographs at six months follow-up.
Conclusions: Both groups presented satisfactory results after being managed by different surgical techniques.
Keywords: Elbow instability, elbow dislocation, collateral ligaments.


References

1. O’Driscoll S. Elbow dislocations. In: Morrey B, editor. The elbow and its disorders. Philadelphia: Saunders Elsevier; 2009. p. 436-49.
2. Vollans S, van Riet R, Elbow instability, Orthopaedics and Trauma (2016), http://dx.doi.org/10.1016/ j.mporth.2016.05.011 (Article in press)
3. Karbach L, Elbar J. Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing . J Hand Surg Am 2017;42(2):118-126.
4. Ahmed I, Mystri J. The Management of Acute and Chronic Elbow Instability. Orthop Clin N Am 2015;46(2):271–280.
5. Hotchkiss R. Fractures and dislocations of the elbow. In: Rockwood C, Green D, Bucholz R, Heckman J, editors. Rockwood and Green’s fractures in adults. Philadelphia: Lippincott-Raven; 1996. p. 929-1024.
6. Morrey B. Funtional evaluation of the elbow. In: Morrey B, editor. The elbow and its disorders. Philadelphia: W.B. Saunders, 1993. p. 86-89.
7. Hudak P, Amadio P, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996;30(3):372-79.
8. O’Driscoll S, Bell D, Morrey B. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 1991;73(3):440-6.
9. O’Driscoll, Jupiter J, Cohen M, Ring D, McKee M. Instr Course Lect 2003;52:113-34.
10. Garrigues G, Wray W, Lindenhovius A, Ring D, Ruch D. Fixation of the coronoid process in elbow fracture-dislocations. J Bone Joint Surg Am 2011;93:1873-81.
11. Cohen M. Chronic elbow instability ligament reconstruction. In: Wolfe S, Hotchkiss R, Pederson W, Kozin S, Cohen M editors.Green’s operative hand surgery. Philadelphia: Elsevier; 2017. p. 803-42.
12. Rooker J, Smith J, Amirfeyz R. Anatomy, surgical approaches and biomechanics of the elbow. Orthopaedics and trauma 2016;30(4):283-90.
13. O’Driscoll S, Lawton R, Smith A. The “moving valgus stress test” for medial collateral ligament tears of the elbow.Am J Sports Med 2005;33(2):231-9
14. O’Driscoll S, Classification and evaluation of recurrent instability of the elbow.Clin Orthop Relat Res 2000;(370):34-43.
15. Singleton S, Conway J. PLRI: posterolateral rotatory instability of the elbow.Clin Sports Med 2004;23(4):629-42.
16. Jennings J, Hahn A, Rehman S, Haydel C. Management of adult elbow fracture dislocations. Orthop Clin N Am 2016;47:97-113.
17. Sanchez-Sotelo J, Morrey B, O’Driscoll S. Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow.J Bone Joint Surg Br 2005;87(1):54-61.
18. Anakwenze O, Kwon D, O’Donnell E, Levine W, Ahmad C. Surgical treatment of posterolateral rotatory instability of the elbow. Arthroscopy 2014;30(7):866–71.
19. Lin K, Shen P, Lee C, Pan R, Lin L, Shen H. Functional outcomes of surgical reconstruction for posterolateral rotatory instability of the elbow. Injury, Int. J. Care Injured 2012;43(10):1657–61.
20. Vernet E, Bacle G, Marteau E, Favard L, Laulan J. Lateral elbow ligamentoplasty by autologous tendon graft in posterolateral rotatory instability: Results in 18 cases at a mean 5 years’ follow-up. Orthop Traumatol Surg Res 2015;101:S199-S202
21. Jones K, Dodson C, Osbarh D, Parisien R, Weiland A, Altchek D, Allen A.The docking technique for lateral ulnar collateral ligament reconstruction: surgical technique and clinical outcomes.J Shoulder Elbow Surg2012;21(3):389-95.
22. O’Driscoll S, Morrey B, Korinek S, An K. Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res 1992;(280):186-97.
23. Dyer G, Jupiter J. Complex traumatic elbow dislocations. In: Wolfe S, Hotchkiss R, Pederson W, Kozin S, Cohen M editors. Green’s operative hand surgery. Philadelphia: Elsevier; 2017. p. 813-29.
24. Jobe F, Stark H, Lombardo S. Reconstruction of the ulnar collateral ligament in athletes.J Bone Joint Surg Am 1986;68(8):1158-63.
25. Bennett J, Mehlhoff T. Reconstruction of the medial collateral ligament of the elbow. J Hand Surg 2009;34A:1729–33.
26. Vitale M, Ahmad C. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review.Am J Sports Med 2008;36(6):1193-205.
27. Cain E, Andrews J, Dugas J, Wilk K, McMichael C, Walter J, Riley, R, Arthur S. Outcome of Ulnar Collateral Ligament Reconstruction of the Elbow in 1281 Athletes: Results in 743 Athletes With Minimum 2-Year Follow-up. Am J Sports Med 2010;38(12):2426-34.
28. Watson, J McQueen P, Hutchinson M. A systematic review of ulnar collateral ligament reconstruction techniques.Am J Sports Med2014;42(10):2510-6.
29. Wells J, Ablove R. Coronoid Fractures of the Elbow. Clin Med Res 2008;6(1):40-44.
30. Hull J, Owen J, Fern S, Wayne J, Boardman N. Role of the coronoid process in varus osteoarticular stability of the elbow.J Shoulder Elbow Surg2005;14(4):441-6.
31. Terada N, Yamada H, Seki T, Urabe T, Takayama S. The importance of reducing small fractures of the coronoid process in the treatment of unstable elbow dislocation. J Shoulder Elbow Surg 2000;9:344-6.


How to Cite this article: Cichero FP, Larrondo W, Castellaro JA, Díaz G, Terán J. Experience of surgical management of acute and chronic post-traumatic elbow instability. A retrospective study. Acta of Shoulder and Elbow Surgery July – Dec 2017;2(2):5-8.

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